| 1. |
- Ahlqvist, Margary, et al.
(författare)
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Handling of peripheral intravenous cannulae : effects of evidence-based clinical guidelines.
- 2006
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 15:11, s. 1354-61
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses' care, handling and documentation of peripheral intravenous cannulae. BACKGROUND: Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. DESIGN: A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. METHOD: A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses' care, handling and the documentation of peripheral intravenous cannulae in the patient's record. RESULTS: A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0.01) and the use of cannula size 0.8 mm increased by 22% (P < 0.001). Nurses' documentation of peripheral intravenous cannula improved significantly (P < 0.001). CONCLUSION: We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0.8 mm), as well as of the nurses' documentation in the patient's record. RELEVANCE TO CLINICAL PRACTICE: Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses' knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.
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| 2. |
- Anandavadivelan, Poorna, et al.
(författare)
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Blood flow restriction Exercise in the perioperative setting to Prevent loss of muscle mass in patients with pancreatic, biliary tract, and liver cancer : study protocol for the PREV-Ex randomized controlled trial.
- 2024
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Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients diagnosed with pancreatic, biliary tract, and liver cancer often suffer from a progressive loss of muscle mass. Given the considerable functional impairments in these patients, high musculoskeletal weight loads may not be well tolerated by all individuals. The use of blood-flow restricted resistance training (BFR-T) which only requires low training loads may allow for a faster recovery of muscle due to avoidance of high levels of mechanical muscle stress associated with high-load resistance exercise. This study aims to investigate whether BFR-T can prevent or slow down the loss of skeletal muscle mass and enhance the functional capacity and mental health of patients with pancreatic, biliary tract, and liver cancer.METHODS: The PREV-Ex exercise trial is a multicenter two-armed randomized controlled trial. Patients will be randomized to an exercise program consisting of home-based low-load BFR-T during a combined pre- and postoperative period for a total of 6-10 weeks (prehabilitation and rehabilitation), or to a control group. Protein supplementation will be given to both groups to ensure adequate protein intake. The primary outcomes, skeletal muscle thickness and muscle cross-sectional area, will be assessed by ultrasound. Secondary outcomes include the following: (i) muscle catabolism-related and inflammatory bio-markers (molecular characteristics will be assessed from a vastus lateralis biopsy and blood samples will be obtained from a sub-sample of patients); (ii) patient-reported outcome measures (self-reported fatigue, health-related quality of life, and nutritional status will be assessed through validated questionnaires); (iii) physical fitness/performance/activity (validated tests will be used to evaluate physical function, cardiorespiratory fitness and maximal isometric muscle strength. Physical activity and sedentary behavior (assessed using an activity monitor); (iv) clinical outcomes: hospitalization rates and blood status will be recorded from the patients' medical records; (v) explorative outcomes of patients' experience of the exercise program which will be evaluated using focus group/individual interviews.DISCUSSION: It is worthwhile to investigate new strategies that have the potential to counteract the deterioration of skeletal muscle mass, muscle function, strength, and physical function, all of which have debilitating consequences for patients with pancreatic, biliary tract, and liver cancer. The expected findings could improve prognosis, help patients stay independent for longer, and possibly reduce treatment-related costs.TRIAL REGISTRATION: ClinicalTrials.gov NCT05044065. Registered on September 14, 2021.
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| 3. |
- Sunde, Berit
(författare)
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Health related quality of life and swallowing problems in oesophageal cancer
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Poor overall survival, swallowing problems and severe side-effects from multi-modality treatment characterize the situation of patients with oesophageal and gastro oesophageal junction carcinoma (GOJ). With the poor prognosis and abundance of symptoms in this disease it is particularly important to consider health-related quality of life (HRQoL) as an important outcome in clinical decision-making. Several trials have addressed outcomes regarding oncological therapies and surgery, though patient-reported outcomes (PRO) are to a large extent lacking in trials on oesophageal cancer patients. This thesis addresses and aims to shed light on PRO and HRQoL with a special reference to swallowing problems (dysphagia) during and after neoadjuvant treatment and after surgery in oesophageal and GOJ carcinoma. Also, an aim is to report HRQoL collected one year after diagnosis in a Swedish population-based register. The current main curative intent treatment regime used for oesophageal cancer is multimodal, including neoadjuvant oncological treatment and surgery. Due to a scarcity of research it is still unknown whether the addition of radiotherapy to neoadjuvant chemotherapy affects HRQoL and swallowing problems. In Sweden and Norway, a multi-centre randomised controlled trial compared neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) prior to surgery, acronymed NeoRes, and PRO using HRQoL instruments was and endpoint in the trial. At diagnosis, the vast majority of the patients were in the palliative stage. Thus, adding knowledge of HRQoL outcomes in these settings is also very important. Paper I describes HRQoL outcomes collected in a nationwide Swedish population-based register twelve months after diagnosis. The outcomes were compared with a Swedish reference population and suggests that at one year after diagnosis of oesophageal cancer, subjects suffer with regard to most of the HRQoL aspects measured compared to the reference population, and particularly in the case of a palliative treatment intent. In addition, high levels of anxiety were reported in all subgroups and problems with swallowing were increased among those who received a palliative diagnosis and in those who were treated with definitive chemoradiotherapy. This study is important in order to increase knowledge of HRQoL outcomes in an unselected, a nation-wide population-based cohort. Paper II, addresses patients treated with neoadjuvant therapy, at the Karolinska University Hospital. These patients were assessed regarding dysphagia prior to any treatment, after the first cycle of chemotherapy and after completion of neoadjuvant therapy, prior to surgery. Patients reported dysphagia relief as already after the first cycle of chemotherapy, and after completed neoadjuvant therapy. This study is important for clinical decision-making at diagnosis of oesophageal cancer, suggesting that stents or gastrostomies may not be needed during neoadjuvant treatment, before surgery. Paper III addresses patient-reported dysphagia in the NeoRes trial. The data were collected before any treatment and after the conclusion of neoadjuvant therapy. In addition, we investigated whether dysphagia was correlated to histological response. This study confirmed the results of paper II, with an improved ability to eat solid food in both groups, although radiotherapy may also add side-effects that contribute to swallowing-problems. However, no correlation was detected between dysphagia response and histological response. Paper IV investigated the HRQoL outcome in the NeoRes trial, measured prior to treatment, after ended neoadjuvant treatment and one, three and five years after surgery. In comparisons between groups, differences were reported by patients regarding odynophagia after the termination of neoadjuvant therapy and coughing at three-year follow-up, both these symptoms was worse in patients treated with nCRT, compared to those receiving nCT. In addition, changes within groups in comparison with baseline were analysed. One finding is that regarding oesophageal-specific symptoms patients reported improvement to some extent. Conversely, functions and known treatment-related side-effects worsened after neoadjuvant therapy in both groups. In cnclusion, patients reported significantly more severe symptoms and decreased functions after the termination of neoadjuvant treatment, and at three- and five-years follow-up, when radiotherapy was added.
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| 4. |
- Sunde, Berit, et al.
(författare)
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Health-related quality of life one year after the diagnosis of oesophageal cancer : a population-based study from the Swedish National Registry for Oesophageal and Gastric Cancer
- 2021
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Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population-based patient reported outcome data in oesophageal cancer are rare. The main purpose of this study was to describe health-related quality of life (HRQOL) 1 year after the diagnosis of oesophageal cancer, comparing subgroups of curatively and palliatively managed patients. Methods: This is a nationwide population-based cohort study, based on the Swedish National Registry for Oesophageal and Gastric Cancer (NREV) with prospectively registered data, including HRQOL instruments from the European Organisation for Research and Treatment of Cancer including the core and disease specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Patients diagnosed with oesophageal cancer between 2009 and 2016 and with complete HRQOL data at 1 year follow-up were included. HRQOL of included patients was compared to a reference population matched by age and gender to to a previous cohort of unselected Swedish oesophageal cancer patients. Linear regression was performed to calculate mean scores with 95% confidence intervals (CI) and adjusted linear regression analysis was used to calculate mean score differences (MD) with 95% CI. Results: A total of 1156 patients were included. Functions and global health/quality of life were lower in both the curative and palliative cohorts compared to the reference population. Both curatively and palliatively managed patients reported a severe symptom burden compared to the reference population. Patients who underwent surgery reported more problems with diarrhoea compared to those treated with definitive chemoradiotherapy (dCRT) (MD -14; 95% CI − 20 to − 8). Dysphagia was more common in patiens treated with dCRT compared to surgically treated patients (MD 11; 95% CI 4 to 18). Those with palliative intent due to advanced tumour stage reported more problems with dysphagia compared to those with palliative intent due to frailty (MD -18; 95% CI − 33 to − 3). Conclusions: One year after diagnosis both curative and palliative intent patients reported low function scores and severe symptoms. Dysphagia, choking, and other eating related problems were more pronounced in palliatively managed patients and in the curative intent patients treated with dCRT.
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| 5. |
- Sunde, Carl, 1976, et al.
(författare)
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Research and Development Program in Reactor Diagnostics and Monitoring with Neutron Noise Methods, Stage 11 and 12, Final report
- 2006
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report gives an account of the work performed by the Department of Nuclear Engineering, Chalmers University of Technology, in the frame of a research contract with the Swedish Nuclear Power Inspectorate (SKI), contract No. 14.5-2004103-20040521 and contract No. 2005/1199-20050513. The present report is based on work performed by Carl Sunde, Christophe Demazière, Berit Dahl, Larisa Mileshina and Imre Pázsit, with the latter being the project leader. This report describes the results obtained during Stage 11 and 12 of a long-term research and development program concerning the development of diagnostics and monitoring methods for nuclear reactors. The long-term goals are elaborated in more detail in e.g. the Final Reports of stage 1 and 2. A brief proposal for the continuation of this program in Stage 13 is also given at the end of the report. The program executed in Stage 11 and 12 consists of fiveparts and the work performed in each part is summarized below.Development of core calculational methods for calculating higher eigenvalues and eigenfunctionsHigher order eigenfunctions and eigenvalues of the diffusion equation, describing a static core, have lost their significance when doing calculations in realistic systems, since there are usually made by nodal methods or other direct numerical techniques. However, there are situations when knowledge of the higher order modes is still useful. Such case is the separation of the global and regional flux oscillations in the case of BWR instability. Another case is the investigation of the stability properties of large inhomogeneous cores, which is usually quantified with the so-called eigenvalue separation, ES=1/k1-1/k0 where k0 and k1 are the fundamental and first higher order eigenvalues, respectively. Numerical codes used for ICMF calculations usually do not have the option of calculating the higher order eigenvalues and eigenfunctions. In idealised systems, these can be calculated with semi-analytical methods (the eigenvalue is determined numerically from a transcendental equation, but the eigenfunctions are simple trigonometric or hyperbolic functions). In order to get insight into the characteristics of the higher order eigenmodes of the neutron flux and the adjoint, these were calculated in a reflected homogeneous system with two-group theory. The adjoint eigenmodes are necessary if an orthogonality property needs to be used, such as the separation of the modes from a flux shape which is a sum of several eigenmodes. At the same time, the so-called numerical noise simulator, developed at the Department, was extended such that it became suitable for the calculation of the higher order eigenmodes, both direct and adjoint ones. This simulator can treat real inhomogeneous cores, with an input deck compatible with that of SIMULATE. It had a static module from the beginning, because it is essential that the algorithm for the dynamic part works with data that belong to a critical core. This static module was now developed further such that it can calculate higher eigenmodes. The simulator was used to calculate the eigenfunctions and eigenvalues in the same model system as the ones in which the semi-analytical calculations were made. Excellent agreement was found between the two methods. Calculations were made in a large and a small system, and the decay of the higher eigenvalues with the order number could be compared. Since the benchmark showed the correct functioning of the simulator, it can be used in the continuation for treating real inhomogeneous systems.Investigation of reactor kinetics and dynamics in a reflected 2-groups systemThe validity and applicability of the point kinetic approximation in noise diagnostic applications was investigated thoroughly in the past. However, most of these investigations were performed in one-group theory and homogeneous, non-reflected systems. It is clear that in such systems the dynamical properties depend on the neutronic coupling in the core through the neutron chains. On the other hand, the conclusions drawn from such models are not necessarily valid in all situations. This is especially the case then the detector is situated in the reflector, where no neutron multiplication takes place, and the dynamics is not determined by the fission process. For example when measuring the reactivity in a core under loading, an extra detector can only be put outside the fuel assemblies already in place. The difference between the core behaviour and the detection in the reflector was observed for instance in the recently finished EU 5th Framework Program MUSE, which showed that the results of pulsed neutron measurements with detectors situated in the reflector could not be interpreted by the conventional theory, based on homogeneous system. It is therefore interesting to investigate the behaviour of reflected systems in two-group theory, and to compare it with the point kinetic behaviour. The investigations of such cases was hindered in the past by the fact that the analytical treatment is cumbersome even in a homogeneous reflected core, and prohibitively complicated in non-homogeneous cores. However, the noise simulator, mentioned above, is a very suitable tool to investigate this question. It was thus used in a 2-dimensional model of a realistic reactor, supposed to run in a subcritical state, driven by a source. It was meant to simulate a core under loading. For the sake of comparison, a small system was also investigated. The full space-frequency response of the system to fluctuations of the source strength were calculated, and compared to the point kinetic response, also calculated by the simulator. The so-called break frequency method of determining the reactivity was also investigated. It was found that the system behaviour deviated from the point kinetic one quite markedly even in the small system, and that the break frequency method showed a relatively large error, that depended on the position of the detector used.Development of the theory of neutron fluctuations in a system varying randomly in time with the master equation approachZero power noise and power reactor noise are two different branches of the field of neutron noise. They depend on different underlying physical processes (branching in a static system, and fluctuations of the cross sections in the reactor, respectively); they are dominating in two different power regimes (low or "zero" power and high power, respectively); and last, but not least, they are treated with two completely different methods. The case of neutron noise in static low power systems is described by the master or Chapman-Kolmogorov equations for the probability distribution of the neutron number, whereas power reactor noise, induced by the fluctuations of the reactor material at high power, is treated by the Langevin technique, for the neutron flux as a stochastic process. For both the completeness of the description, and to describe the co-existence of zero power and power reactor noise in intermediate power systems, a model system with fluctuating parameters was treated by the master equation method. The first and second moments of the neutron distribution were calculated both for chains started by one single neutron, and by a stationary source. A number of new results were obtained, that are described in Section 3. First of all it was shown that the backward equation treatment is not applicable in systems with fluctuating parameters. The concept of criticality had to be generalised to "criticality in the mean", and it was shown that a system whose state fluctuates between a subcritical and a supercritical state, can be made critical with a given special combination of the system properties in the two states and the frequency of system state changes. For systems critical in the mean, the variance diverges exponentially, as opposed to the known linear divergence in static systems. It was also shown that in the case of low power, the fluctuations of the system parameters gives a contribution to the zero power noise, whereas at high power, the zero power noise component, arising from the branching (fission process) is indeed negligible and for small system changes (weak perturbations) the result obtained from the master equation approach agrees with that from the Langevin technique.Simulations of Feynman- or Rossi-alpha-methods for reactivity measurements of fissile material using MCNP-PoliMiSimulation of pulse trains of neutrons coming from a multiplying sample, or trains of detector counts caused by such particles, is very useful for studying stochastic reactivity measurement methods, such as the Feymnan- or Rossi-alpha methods, or problems in nuclear material control (safeguards). Such simulations can though not performed by the traditional Monte Carlo codes, since these do not sample the neutron histories with their full statistics. Besides, to speed up the calculations of the mean value, they use variance reduction techniques, which change the properties of the higher order moments, which are needed to the reactivity measurement or safeguards methods. Recently some Monte Carlo codes were extended with the possibility of performing simulations that reconstruct the full statistics of the neutron generation and transport. We have obtained and installed the code MCNP-PoliMi, which has the most general stochastic capability for doing time-dependent calculations for both neutrons and photons. The first application of the code was its use in a safeguards benchmark exercise. In the work performed in Stage 12, pulse trains were generated in systems close to criticality, such that the obtained pulse train was suitable for simulating a Feynman-alpha or Rossi-alpha experiment. This consisted of two steps. First a system had to be designed that was slightly subcritical. For this, the traditional MCNP had to be run, because there is no option of calculating keff with MCNP-PoliMi. In the second
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| 6. |
- Wode, Kathrin, et al.
(författare)
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Efficacy of mistletoe extract as a complement to standard treatment in advanced pancreatic cancer : study protocol for a multicentre, parallel group, double-blind, randomised, placebo-controlled clinical trial (MISTRAL)
- 2020
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most pancreatic cancer patients present with advanced stage at diagnosis with extremely short expected survival and few treatment options. A multimodal palliative approach is necessary for symptom relief and optimisation of health-related quality of life. In a recent open-label trial of mistletoe extract for advanced pancreatic cancer patients not eligible for chemotherapy, promising results on improved overall survival and better health-related quality of life were reported.The objective of the present study is to assess the value of mistletoe extract as a complement to standard treatment (palliative chemotherapy or best supportive care) in advanced pancreatic cancer patients with regard to overall survival and health-related quality of life.Methods: The trial is prospective, randomised, double-blind, multicentre, parallel group and placebo-controlled. In total, 290 participants are randomly assigned to placebo or mistletoe extract given subcutaneously in increasing dosage from 0.01 to 20 mg three times per week for 9 months. Stratification is performed for site and palliative chemotherapy. Main inclusion criteria are advanced pancreatic cancer and Eastern Cooperative Oncology Group performance status 0 to 2; main exclusion criteria are life expectancy less than 4 weeks and neuroendocrine tumour of the pancreas. Two ancillary studies on sub-sets of participants are nested in the trial: a biomarker study collecting blood samples and a cross-sectional qualitative study with semi-structured face-to-face interviews.Discussion: To our knowledge, this is the first placebo-controlled randomised trial assessing the impact of mistletoe extract as a complement to standard treatment on overall survival and health-related quality of life in patients with advanced pancreatic cancer. The presented trial with its two nested ancillary studies exploring biomarkers and patient experiences is expected to give new insights into the treatment of advanced pancreatic cancer.
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